Social Rhythm Disruption Research Articles

Moderating effect of shift work on sleep and depression in individuals at high risk of bipolar disorder

BackgroundSocial Zeitgeber Theory posits that disruptions in social rhythms can increase susceptibility to bipolar disorder (BD). Shift work (SW) is one of the external factors that cause instability in social rhythms and the sleep-wake cycle. This study evaluated the moderating influences of SW on the risks of BD and sleep-related parameters and depressive symptoms. Furthermore, we evaluated the specific work schedules including daytime, nighttime, and regular and irregular rotating SW. MethodsAn online survey was administered to 6665 participants, with 3379 (50.7 %) classified as individuals with high scores of Mood Disorder Questionnaire (MDQ). The survey included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Scale (ISI), Epworth Sleepiness Scale (ESS), and Center for Epidemiologic Studies Depression Scale (CES-D). ResultsA multivariate regression model revealed significant interactive effects of MDQ positivity and SW on PSQI, ISI, and CES-D scores, but not ESS scores. In a secondary analysis of the high MDQ screen group, daytime workers had lower scores in sleep disturbances and depressive symptoms compared to those engaged in other forms of SW. LimitationsOnline surveys were accessible voluntarily, leading to potential selection bias. Cross-sectional data identified associations, not causal relationships. Only a self-reported questionnaire was used. ConclusionsOur findings emphasize the advantages of a daytime work schedule for individuals at high risk of BD. In accordance with the principles of social rhythm interpersonal therapy, sleep interventions for individuals at high risk of BD should include the maintenance of a consistent daytime schedule.

Reward sensitivity and social rhythms during goal-striving: An ecological momentary assessment investigation of bipolar spectrum disorders

BackgroundThe reward/circadian rhythm model of bipolar spectrum disorders (BSDs) posits that when individuals with hypersensitive reward systems encounter reward-relevant events, they experience social and circadian rhythm disruption, leading to mood symptoms. The aim of the current study is to test an element of this theoretical model by investigating changes in social rhythms during and after an ecologically-valid reward-relevant event and evaluating whether the strength of these associations differ by trait reward sensitivity and BSD diagnostic group. MethodsYoung adults from three groups (low BSD risk with moderate reward sensitivity [MRew], high BSD risk with high reward sensitivity [HRew], and high reward sensitivity with BSD [HRew+BSD]) completed a reward responsiveness task and 20-day ecological momentary assessment study structured around a participant-specific goal occurring on day 15. Social rhythm disruption (SRD) and social rhythm regularity (SRR) were assessed daily. Multilevel models examined whether reward sensitivity and group moderated associations between study phase (baseline [days 1–5], goal-striving [days 16–20], or outcome [days 16–20]) and social rhythms. ResultsParticipants experienced greater SRD after the goal-striving event during the outcome phase, compared to the baseline phase. The HRew+BSD group had significant decreases in SRR during the outcome phase, and this pattern differed significantly from the low-risk and high-risk groups. Greater task reward responsiveness also was associated with significant decreases in SRR during the outcome phase. LimitationsThis study did not test whether social rhythm irregularity was associated with subsequent mood change. ConclusionsParticipants exhibited social rhythm changes over the course of this ecologically valid goal-striving period, providing evidence for the interplay between reward-activating events and social rhythms. The HRew+BSD group showed a distinct pattern in which their social rhythms were more irregular after completing reward-relevant goal-striving that was not observed for the low-BSD risk or high-BSD risk groups. These findings provide additional support for Interpersonal and Social Rhythms Therapy.

Circadian, Reward, and Emotion Systems in Teens prospective longitudinal study: protocol overview of an integrative reward-circadian rhythm model of first onset of bipolar spectrum disorder in adolescence

BackgroundBipolar spectrum disorders (BSDs) are associated with a heightened sensitivity to rewards and elevated reward-related brain function in cortico-striatal circuitry. A separate literature documents social and circadian rhythm disruption in BSDs. Recently, integrated reward-circadian models of BSDs have been proposed. These models draw on work indicating that the two systems influence each other and interact to affect mood functioning. When dysregulated, reward and circadian system signaling may combine to form a positive feedback loop, whereby dysregulation in one system exacerbates dysregulation in the other. Project CREST (Circadian, Reward, and Emotion Systems in Teens) provides a first systematic test of reward-circadian dysregulation as a synergistic and dynamic vulnerability for first onset of BSD and increases in bipolar symptoms during adolescence.MethodsThis NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 320 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13–16 years old, fluent in English, and without a prior BSD or hypomanic episode. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the high tail of the dimension in order to increase the likelihood of BSD onsets. At Times 1–6, every 6 months, participants will complete assessments of reward-relevant and social rhythm disruption life events and self-report and diagnostic assessments of bipolar symptoms and episodes. Yearly, at Times 1, 3, and 5, participants also will complete self-report measures of circadian chronotype (morningness-eveningness) and social rhythm regularity, a salivary dim light melatonin onset (DLMO) procedure to assess circadian phase, self-report, behavioral, and neural (fMRI) assessments of monetary and social reward responsiveness, and a 7-day ecological momentary assessment (EMA) period. During each EMA period, participants will complete continuous measures of sleep/wake and activity (actigraphy), a daily sleep diary, and three within-day (morning, afternoon, evening) measures of life events coded for reward-relevance and social rhythm disruption, monetary and social reward responsiveness, positive and negative affect, and hypo/manic and depressive symptoms. The fMRI scan will occur on the day before and the DLMO procedure will occur on the first evening of the 7-day EMA period.DiscussionThis study is an innovative integration of research on multi-organ systems involved in reward and circadian signaling in understanding first onset of BSD in adolescence. It has the potential to facilitate novel pharmacological, neural, and behavioral interventions to treat, and ideally prevent, bipolar conditions.

Social Rhythm Disruption is Associated with Greater Depressive Symptoms in People with Mood Disorders: Findings from a Multinational Online Survey During COVID-19.

ObjectivesSocietal restrictions imposed to prevent transmission of COVID-19 may challenge circadian-driven lifestyle behaviours, particularly amongst those vulnerable to mood disorders. The overarching aim of the present study was to investigate the hypothesis that, in the routine-disrupted environment of the COVID-19, amongst a sample of people living with mood disorders, greater social rhythm disruption would be associated with more severe mood symptoms.MethodsWe conducted a two-wave, multinational survey of 997 participants who self-reported a mood disorder diagnosis (i.e., major depressive disorder or bipolar disorder). Respondents completed questionnaires assessing demographics, social rhythmicity (The Brief Social Rhythm Scale), depression symptoms (Patient Health Questionnaire-9), sleep quality and diurnal preference (The Sleep, Circadian Rhythms and Mood questionnaire) and stressful life events during the COVID-19 pandemic (The Social Readjustment Rating Scale).ResultsThe majority of participants indicated COVID-19-related social disruption had affected the regularity of their daily routines to at least some extent (n = 788, 79.1%). As hypothesised, lower social rhythmicity was associated with greater depressive symptoms when tested cross-sectionally (standardised β = −.25, t = −7.94, P = 0.000) and when tested using a 2-level hierarchical linear model across two time points (b = −0.14, t = −3.46, df = 264, P ≤ 0.001).ConclusionsThese results are consistent with the social zeitgeber hypothesis proposing that mood disorders are sensitive to life events that disrupt social rhythms.

Social rhythm disruption, psychosocial stressors, and the COVID-19 pandemic: Possible role of interpersonal and social rhythm therapy

Social rhythm disruption, psychosocial stressors, and the COVID-19 pandemic: Possible role of interpersonal and social rhythm therapy

Reward Sensitivity and Social Rhythm Disruption During Goal-Striving: A Phase-Temporal Approach to Ecological Momentary Assessment Data

The integrative Reward/Circadian Rhythm (RCR) model suggests that when individuals with hypersensitive reward systems encounter reward-relevant life events (i.e., engage in goal-striving), they experience increased social rhythm disruption (SRD), which triggers mood symptoms. This study tests elements of this hypothesis using an ecological momentary assessment (EMA) design.

Social rhythms and occupational functioning disturbance in remitted bipolar patients

IntroductionBiological rhythm disturbance is etiologically involved in mood disorders. Previous literature focused on studying sleep disruption in bipolar disorders (BD). However, only a few studies addressed the influence of social rhythms and occupational functioning as they may affect circadian regularity and consequently be a critical pathway to mood symptoms.ObjectivesThe main aim of this study was to assess biological rhythms in remitted bipolar patients and to evaluate their social rhythms and occupational functioning.MethodsWe recruited a total of 80 euthymic outpatients with BD and 80 control subjects. Biological rhythm disruptions were assessed using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity.ResultsPatients with BD experienced greater biological rhythm alterations than the control group (BRIAN total scores 35.26±9.21 vs. 25.84±2.68). In addition to their sleep-wake rhythm (mean scores 11.1±3.95 vs. 7.41±1.41), patients were particularly more impaired than the control group with regards to social rhythms (7.31 ± 2.57 vs. 5.24 ± 1.06) and general activity (8.9 ± 3.35 vs. 7.01 ± 1.4).ConclusionsOur study indicated that patients with BD experience major disruptions in their social rhythms and occupational functioning. These alterations may lead to unstable biological rhythms and to a higher risk of mood episodes. Therefore, consolidating social rhythms and functioning appears to be a crucial step for preventing relapses in patients with BD.DisclosureNo significant relationships.

Longitudinal assessment of daily activity patterns on weight change after involuntary job loss: the ADAPT study protocol

BackgroundThe World Health Organization has identified obesity as one of the most visible and neglected public health problems worldwide. Meta-analytic studies suggest that insufficient sleep increases the risk of developing obesity and related serious medical conditions. Unfortunately, the nationwide average sleep duration has steadily declined over the last two decades with 25% of U.S. adults reporting insufficient sleep. Stress is also an important indirect factor in obesity, and chronic stress and laboratory-induced stress negatively impact sleep. Despite what we know from basic sciences about (a) stress and sleep and (b) sleep and obesity, we know very little about how these factors actually manifest in a natural environment. The Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study tests whether sleep disruption plays a key role in the development of obesity for individuals exposed to involuntary job loss, a life event that is often stressful and disrupting to an individual’s daily routine.MethodsThis is an 18-month closed, cohort research design examining social rhythms, sleep, dietary intake, energy expenditure, waist circumference, and weight gain over 18 months in individuals who have sustained involuntary job loss. Approximately 332 participants who lost their job within the last 3 months are recruited from flyers within the Arizona Department of Economic Security (AZDES) Unemployment Insurance Administration application packets and other related postings. Multivariate growth curve modeling will be used to investigate the temporal precedence of changes in social rhythms, sleep, and weight gain.DiscussionIt is hypothesized that: (1) unemployed individuals with less consistent social rhythms and worse sleep will have steeper weight gain trajectories over 18 months than unemployed individuals with stable social rhythms and better sleep; (2) disrupted sleep will mediate the relationship between social rhythm disruption and weight gain; and (3) reemployment will be associated with a reversal in the negative trajectories outlined above. Positive findings will provide support for the development of obesity prevention campaigns targeting sleep and social rhythms in an accessible subgroup of vulnerable individuals.

Social rhythm disrupting events increase the risk of recurrence among individuals with bipolar disorder.

As outlined in the social zeitgeber hypothesis, social rhythm disrupting (SRD) life events begin a cascade of social and biological rhythm disruption that may lead to the onset of affective episodes in those vulnerable to bipolar disorder. Thus, the study of SRD events is particularly important in individuals with this chronic condition. The purpose of the current study was to evaluate (i) the extent to which SRD life events increased the risk of recurrence of a bipolar mood episode, and (ii) whether the social rhythm disruption associated with the event conferred an increased risk of recurrence, after accounting for the level of threat associated with the life event. We examined the effect of SRD events on recurrence during preventative treatment in a sample of 118 patients with bipolar disorder who achieved remission from an acute episode after receiving psychotherapy and pharmacotherapy. Life events were measured with the Bedford College Life Events and Difficulty Schedule and were rated for degree of SRD and threat. Time-dependent Cox proportional hazards models showed that having a higher SRD rating was significantly associated with an increased risk of recurrence, even when accounting for the threat effect of a life event and psychosocial treatment (hazard ratio=1.33, 95% confidence interval: 1.04-1.70, p=0.023). However, this finding fell below conventional levels of statistical significance when accounting for other covariates. Our findings lend partial support to the social zeitgeber hypothesis.

Affective Disruption from Social Rhythm and Behavioral Approach System (BAS) Sensitivities: A Test of the Integration of the Social Zeitgeber and BAS Theories of Bipolar Disorder.

The Behavioral Approach System (BAS)/Reward Hypersensitivity Theory and the Social Zeitgeber Theory are two biopsychosocial theories of bipolar spectrum disorders (BSD) that may work together to explain affective dysregulation. The present study examined whether BAS sensitivity is associated with affective symptoms via a) increased social rhythm disruption in response to BAS-relevant life events, or b) greater exposure to BAS events leading to social rhythm disruption and subsequent symptoms. Results indicated that high BAS individuals were more likely to experience social rhythm disruption following BAS-relevant events. Social rhythm disruption mediated the association between BAS-relevant events and symptoms (hypothesis a). High BAS individuals experienced significantly more BAS-relevant events, which predicted greater social rhythm disruption, which predicted greater levels of affective symptoms (hypothesis b). Individuals at risk for BSD may be sensitive to BAS-relevant stimuli, experience more BAS-relevant events, and experience affective dysregulation due to the interplay of the BAS and circadian rhythms.

Mild Depressive Symptoms During the Third Trimester of Pregnancy Are Associated with Disruptions in Daily Rhythms but Not Subjective Sleep Quality.

Recent research in major depressive disorder suggests that dysregulation of the circadian system may be a core pathophysiological component. In pregnancy, women often experience significant disruptions in their daily rhythms, including changes in day-to-day schedule and sleep habits. Current evidence suggests that these disruptions in daily rhythms may adversely affect underlying circadian rhythmicity. The purpose of our study was to examine whether subjectively rated daily rhythm disruptions were associated with a greater incidence of depressive symptoms during the third trimester. Our study was a cross-sectional design, assessing sleep quality, symptoms of depression, and daily rhythm disruptions in 51 pregnant women in their third trimester. We observed a significant relationship between mild depressive symptoms and disruptions in daily rhythms. While we initially observed a strong correlation between subjective sleep quality and depressive symptoms, this was attenuated after accounting for daily rhythm disruptions. Disruptions in daily social rhythms, eating patterns, and general activity were all significantly associated with depressive symptomatology. Our findings point to a strong correlation between daily rhythm disruptions and prenatal depressive symptoms. Given that these daily rhythms are known to act as zeitgebers, longitudinal studies examining the directionality of this relationship between circadian rhythms and depressive symptoms during pregnancy are warranted.

Social rhythm interventions for bipolar disorder: a systematic review and rationale for practice.

Three interconnected pathways to relapse have been identified as stressful life events, medication non-adherence and disruptions in social rhythms (daily activity and routine). The role of medication and stressful life events is generally better understood than the role of social rhythms. There is no previous review of interventions that target social rhythms. To identify the evidence for the effectiveness of interventions that target social rhythms for improving mood symptoms. A quantitative systematic review was conducted. Results Seven studies were included in the review: four reporting interpersonal and social rhythm therapy (IPSRT) interventions and three sleep/light interventions. The results suggest that IPSRT may have a potential benefit in improving mood symptoms and relapse, but it is not clear whether this is of greater benefit than an intensive supportive care intervention of similar duration. The sleep/light interventions demonstrated rapid mood improvements; however, it was not clear how long this improvement was sustained. Attention to social rhythms and the implementation of interventions that target these could be useful for mental health nursing practice may provide people with BD a clinically effective adjunctive intervention to medication.

The association between biological rhythms, depression, and functioning in bipolar disorder: a large multi-center study.

We examined the relationship between biological rhythms and severity of depressive symptoms in subjects with bipolar disorder and the effects of biological rhythms alterations on functional impairment. Bipolar patients (n=260) and healthy controls (n=191) were recruited from mood disorders programs in three sites (Spain, Brazil, and Canada). Parameters of biological rhythms were measured using the Biological Rhythms Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity. Multivariate analyses of covariance showed significant intergroup differences after controlling for potential confounders (Pillai's F=49.367; df=2, P<0.001). Depressed patients had the greatest biological rhythms disturbance, followed by patients with subsyndromal symptoms, euthymic patients, and healthy controls. Biological rhythms and HAMD scores were independent predictors of poor functioning (F=12.841, df=6, P<0.001, R2 =0.443). Our study shows a dose-dependent association between the severity of depressive symptoms and degree of biological rhythms disturbance. Biological rhythms disturbance was also an independent predictor of functional impairment. Although the directionality of this relationship remains unknown, our results suggest that stability of biological rhythms should be an important target of acute and long-term management of bipolar disorder and may aid in the improvement of functioning.

Life events and social rhythms in bipolar spectrum disorders: An examination of social rhythm sensitivity

To examine the presence of an underlying social rhythm sensitivity in individuals with bipolar spectrum disorders. The present study examined the impact of life events on sleep loss and social rhythm disruption in 184 individuals with bipolar spectrum disorders (BSD) compared to 197 demographically similar normal controls (NC) drawn from the Longitudinal Investigation of Bipolar Spectrum Disorders (LIBS) project. Life events data were obtained at three time points, each spaced four months apart, and included information on the intensity of the event (high or low), valence (negative or positive), and levels of sleep loss and social rhythm disruption brought about the event. We hypothesized that BSD participants would exhibit higher levels of social rhythm disruption and sleep loss than normal controls as a consequence of the same life events. BSD participants experienced significantly more social rhythm disruption and sleep loss following all classes of life events. The cross-sectional design of this study limits the strength of the conclusions that can be drawn, primarily cause and effect relationships between social rhythms and symptoms. Findings support the presence of an underlying social rhythm sensitivity in individuals with bipolar spectrum disorders. An additive effect of sleep loss and social rhythm disruption may contribute to subsequent mood symptomatology. Results from this study may inform early psychosocial interventions for at-risk individuals.

Life Events and Social Rhythms in Bipolar Spectrum Disorders: A Prospective Study

This study examined the social zeitgeber theory, which suggests that affective symptoms are caused by life events disrupting vulnerable individuals’ social and circadian rhythms. Undergraduate participants were selected based on a 2-phase screening process, including a semistructured diagnostic interview. The final sample consisted of 101 bipolar spectrum participants and 100 demographically matched normal controls. Participants who completed up to 3 follow-up visits, approximately every 4 months, as part of a longitudinal study were included in the current study. Life events did not predict social rhythm regularity and social rhythm regularity inconsistently predicted affective symptoms. However, life events, particularly social rhythm disruption (SRD) events, did predict depressive symptoms and episodes, and less consistently predicted hypo(manic) symptoms and episodes. Thus, the current study obtained mixed support for social zeitgeber theory.

Interpersonal and social rhythm therapy: an intervention addressing rhythm dysregulation in bipolar disorder

Bipolar disorder is characterized by frequent recurrences, often related to noncompliance with drug treatment, stressful life events, and disruptions in social rhythms. Interpersonal and social rhythm therapy (IPSRT) was designed to directly address these problem areas. This article discusses the circadian basis of IPSRT and the importance of stable daily routines in the maintenance of the euthymic state, as well as the two large controlled trials which empirically support this intervention. The authors discuss the advantages of IPSRT as an acute intervention, as well as a prophylactic treatment for both bipolar I and II disorder. Using a case example, the authors describe how IPSRT is implemented in a clinical setting, detailing the therapeutic methods and processes involved.

Interpersonal and social rhythm therapy: A means of improving depression and preventing relapse in bipolar disorder

Interpersonal and social rhythm therapy (IPSRT) was designed to directly address the major pathways to recurrence in bipolar disorder, namely medication nonadherence, stressful life events, and disruptions in social rhythms. The efficacy of IPSRT has been supported by two large studies examining it in conjunction with pharmacotherapy in patients with bipolar illness. In this article, the author discusses the advantages of IPSRT as both an acute intervention and a prophylactic treatment for bipolar depression. The author outlines the four phases of IPSRT, indicating the appropriate focus and duration for each, and discusses IPSRT as a modular treatment. The article concludes with a case example that further illustrates the basic therapeutic methods and processes of IPSRT.

Disrupting life events and the sleep-wake cycle in depression

Social rhythm disruption life events are significant predictors of mood relapse in bipolar patients. However, no research has examined the relationship between these events and their hypothesized mechanism of action: disrupted sleep-wake patterns. The goal of this study was to test whether participants with major depressive disorder have a greater disruption of daily sleep and motor activity following disrupting life events when compared to normal controls. Over the course of 2 weeks, 39 normal controls and 39 individuals with major depressive disorder completed life events interviews and wore actigraphs to obtain estimates of sleep/wake activity. Statistically significant interactions indicated that the presence of at least one disrupting life event in the previous 4 months correlated with elevations in the amount of time spent awake after sleep onset [beta=0.45, deltaF(1,73)=4.80, p<0.05], and decreases in the percentage of time spent asleep [beta=-0.53, deltaF(1,73)=6.57, p<0.05], in depressed individuals but not in normal controls. The results indicated that depressed individuals may be more susceptible to the effects of life events on sleep than normal controls. This is the first study to date to correlate life events with objective measures of sleep. However, prospective longitudinal research is necessary to clarify the temporal relationship among these variables.

Illuminating the Impact of Habitual Behaviors in Depression

Researchers have hypothesized that habitual behaviors are zeitgebers for the circadian clock. However, few studies have examined the relationship between habitual behaviors and light, the strongest zeitgeber. Depression is an ideal model in which to explore this relationship because depression is a disorder associated with disruptions in circadian biological activity, sleep, and social rhythms (or patterns of habitual behaviors). We hypothesized that individuals with fewer habitual behaviors have less average exposure to light from morning rise time to evening bedtime and that a reduction in light exposure increases the likelihood of depression. Thirty‐nine depressed and 39 never‐depressed participants wore an ambulatory light monitor and completed the Social Rhythm Metric over the course of 2 weeks. Linear and logistic regression techniques were used to calculate regression coefficients, and confidence limits based on the distribution of the product of two normal random variables were computed to test the significance of the mediation effect. Infrequent habitual behaviors were associated with a decrease in average levels of light exposure, and low levels of light increased the likelihood of depression. This mediation effect was partial; the overall number of habitual behaviors had a direct relationship with depression above and beyond the association with light exposure. Longitudinal studies are needed to empirically demonstrate the direction of relationships between each of the variables tested.

Stress, social rhythms, and behavioral activation: psychosocial factors and the bipolar illness course.

Current, more sophisticated models of bipolar disorder emphasize the interaction of psychosocial factors with biology as determinants of the long-term illness course. Recent research has documented the effects of psychosocial stress on the onset of new episodes, exacerbation of symptoms, and response to pharmacologic treatment in bipolar individuals. In this article, relevant theories and empiric findings regarding these relationships will be reviewed. In particular, two specific pathways relating psychosocial stressors to the onset of mania (eg, social rhythm disruption and behavioral activation) will be explicated.